Healthcare Provider Details

I. General information

NPI: 1174239818
Provider Name (Legal Business Name): APRIL SAMONE BRODAHL CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 CATON WAY SW STE 201
OLYMPIA WA
98502-8201
US

IV. Provider business mailing address

5815 LACEY BLVD SE UNIT 3747
LACEY WA
98503-2459
US

V. Phone/Fax

Practice location:
  • Phone: 260-490-7720
  • Fax:
Mailing address:
  • Phone: 360-490-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number70068622
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: